Good Catch: Stopping Strokes Before They Occur

Jim Kaminer, of Palm Coast, prides himself on being active. A lifelong military man and Orlando native, Jim was always on the go, handling maintenance issues around the house and fishing in his spare time.

Two years ago, after installing new wiring in his attic, he came down from the ladder, red-faced, and was ordered by his wife, Carol, to rest. The next day he went for a routine health check-up.

During the examination, Jim's physician placed a stethoscope to his neck and didn't like what she heard. She sent him immediately to a local hospital, where tests revealed his carotid artery was blocked. Three days later, he had a procedure to clear it.

Two months later, Jim began experiencing numbness in his left arm and shoulder. He shrugged it off, not realizing it could be something more serious. During physical therapy for an unrelated back injury, the pain became unbearable and he was taken straight to the local hospitals emergency department.

More tests were ordered and Jim learned that arteries to his heart were blocked, requiring double bypass surgery, and that his carotid artery had become blocked again, about 90 percent. For treatment, Jim turned to Donald Botta, MD, cardiovascular surgeon, and Mark Ranson, MD, vascular surgeon, who had cared for others in his family.

Jims Treatment Options

If the narrowing of a carotid artery isn't severe, medication may be prescribed to manage the condition. In more serious cases, the blockage can be removed during an operation called an endarterectomy. A third option, the one Jim chose, is carotid stenting.

A stent is a small tube made of metal mesh that's inserted into a vein or artery to hold it open. Its approved for patients who aren't good candidates for traditional surgery, or are at high risk of complications from a traditional operation, says Dr. Ranson.

Although the stenting technique can't be used on all patients, it provides some advantages over endarterectomy, according to Dr. Ranson: There's no incision, either in the neck or the groin, the hospital stay is typically less than 24 hours, and it allows prevention of stroke in patients who might otherwise do poorly with surgery.

How Stenting Works

To place a carotid stent, a balloon catheter (a long, hollow tube) is inserted into the femoral artery in the groin and threaded to the blockage. Once in position, the balloon is inflated to flatten plaque against the arterial wall, where the stent is then deployed. The stent acts like a scaffold to help prevent the artery from narrowing again. The catheter and the filter which catches any debris that may break off during the procedure are removed, explains Dr. Ranson. Patients are fully awake during the procedure and experience little or no discomfort.

Stopping strokes in time

Jim underwent carotid stenting immediately before his open-heart surgery. He says he's grateful to have had the two procedures together because he learned that a blocked carotid artery can lead to a stroke during surgery. If one or both carotid arteries large blood vessels in the neck become narrowed or blocked with plaque, the brain can become starved for oxygen, resulting in a stroke. Carotid artery disease develops slowly and often without symptoms. Blockages account for half the strokes recorded annually in the United States, yet many people are unaware they have it.

Strokes also can occur if plaque within an artery breaks away or ruptures. The resulting clot can travel through the bloodstream and become lodged in a smaller artery, blocking blood flow to the brain. Fortunately, many tests can pinpoint narrowed carotid arteries, including ultrasound, magnetic resonance angiography, computed tomography and others.

These days Jim says if something feels wrong, he won't ignore it. He says he's glad his physician was aware enough to listen to his body, even if he didn't.

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